Association Of Public Health Laboratories Research Articles

Predictors of Capacity in Public Health, Environmental, and Agricultural Laboratories

Ensuring adequate capacity to address population health concerns has challenged public health for decades. Organizational and workforce characteristics are theorized to contribute to organizational capacity. This article considers 2 possible quantitative measures of organizational capacity using public health, environmental, and agricultural laboratories (PHEALs) as the unit of interest and tests their associations with workforce and human resources variables. The National Laboratory Capacity Assessment was developed by the University of Michigan Center of Excellence in Public Health Workforce Studies and the Association of Public Health Laboratories. Online data collection took place from July to September 2011. All statistical analyses were performed in 2013. US PHEALs were invited to participate in the study. All study participants were Association of Public Health Laboratories members. The Association of Public Health Laboratories distributed the National Laboratory Capacity Assessment survey to 105 PHEAL directors in all 50 states, the District of Columbia, and Puerto Rico, including 50 state public health laboratories, 41 local public health laboratories, 8 environmental laboratories, and 6 agricultural laboratories. Logistic regression analyses were performed to assess relationships between outcome measures of overall capacity and averaged program capacity and variables representing characteristics of PHEALs and their workforce, including number of workers, proportion of scientists, education, experience, training, and equipment quality. The survey achieved a 76% response rate. Both capacity models showed that PHEALs offering an array of training opportunities are 4 times more likely to report higher capacity scores. One model showed a positive association between workforce size and capacity. Worker education and equipment quality were negatively associated with capacity in both models. The findings of this study provide empirical evidence that some workforce factors may influence organizational capacity of PHEALs. Techniques used to measure capacity and workforce factors must be improved to produce consistent findings across public health organizational data sets.

Harmonization of Bordetella pertussis Real-Time PCR Diagnostics in the United States in 2012

Real-time PCR (rt-PCR) is an important diagnostic tool for the identification of Bordetella pertussis, Bordetella holmesii, and Bordetella parapertussis. Most U.S. public health laboratories (USPHLs) target IS481, present in 218 to 238 copies in the B. pertussis genome and 32 to 65 copies in B. holmesii. The CDC developed a multitarget PCR assay to differentiate B. pertussis, B. holmesii, and B. parapertussis and provided protocols and training to 19 USPHLs. The 2012 performance exercise (PE) assessed the capability of USPHLs to detect these three Bordetella species in clinical samples. Laboratories were recruited by the Wisconsin State Proficiency Testing program through the Association of Public Health Laboratories, in partnership with the CDC. Spring and fall PE panels contained 12 samples each of viable Bordetella and non-Bordetella species in saline. Fifty and 53 USPHLs participated in the spring and fall PEs, respectively, using a variety of nucleic acid extraction methods, PCR platforms, and assays. Ninety-six percent and 94% of laboratories targeted IS481 in spring and fall, respectively, in either singleplex or multiplex assays. In spring and fall, respectively, 72% and 79% of USPHLs differentiated B. pertussis and B. holmesii and 68% and 72% identified B. parapertussis. IS481 cycle threshold (CT) values for B. pertussis samples had coefficients of variation (CV) ranging from 10% to 28%. Of the USPHLs that differentiated B. pertussis and B. holmesii, sensitivity was 96% and specificity was 95% for the combined panels. The 2012 PE demonstrated increased harmonization of rt-PCR Bordetella diagnostic protocols in USPHLs compared to that of the previous survey.

HIV and hepatitis C virus infection in the United States: whom and how to test.

In the United States, of the 1.1 million persons infected with human immunodeficiency virus (HIV) and the 2.7 million infected with hepatitis C virus (HCV), approximately 16% and 50%, respectively, are unaware of their infection. Highly effective treatments have turned both diseases into manageable conditions, and in the case of hepatitis C, a disease that can be cured. Early diagnosis is imperative so that infected persons can take measures to stay healthy, get into care, benefit from therapy, and reduce the risk of transmission. In this report, we review current recommendations provided by the Centers for Disease Control and Prevention (CDC) and the United States Preventive Services Task Force on whom to screen for HIV and HCV infections, and recommendations from the CDC, the Association of Public Health Laboratories, and the Clinical and Laboratory Standards Institute on how to test for these infections.

Developing a competency framework for U.S. state food and feed testing laboratory personnel.

A competency-based training curriculum framework for U.S. state food and feed testing laboratories personnel is being developed by the International Food Protection Training Institute (IFPTI) and three partners. The framework will help laboratories catalog existing training courses/modules, identify training gaps, inform training curricula, and create career-spanning professional development learning paths, ensuring consistent performance expectations and increasing confidence in shared test results. Ultimately, the framework will aid laboratories in meeting the requirements of ISO/IEC 17025 (2005) international accreditation and the U.S. Food Safety Modernization Act (U.S. Public Law 111-353). In collaboration with the Association of Food and Drug Officials, the Association of Public Health Laboratories, and the Association of American Feed Control Officials, IFPTI is carrying out the project in two phases. In 2013, an expert panel of seven subject matter experts developed competency and curriculum frameworks for five professional levels (entry, mid-level, expert, supervisor/manager, and senior administration) across four competency domains (technical, communication, programmatic, and leadership) including approximately 80 competencies. In 2014 the expert panel will elicit feedback from peers and finalize the framework.

Costs and outcomes of laboratory diagnostic algorithms for the detection of HIV

BackgroundAn alternative HIV testing algorithm, designed to improve the detection of acute and early infections and differentiate between HIV-1 and HIV-2 antibodies, has been developed by the Centers for Disease Control and Prevention and the Association of Public Health Laboratories. While it promises greater sensitivity, it also raises concerns about costs. ObjectiveWe sought to compare the most commonly used algorithm which was developed in 1989, a third-generation (3G) immunoassay (IA) and Western blot confirmatory test, to a newer algorithm. The new algorithm includes either a 3G or a fourth-generation (4G) initial IA, followed by confirmatory testing with a HIV-1/HIV-2 differentiation IA and, if needed, a nucleic acid amplification test (NAT). Study designWe conducted an analysis of HIV testing costs from the perspective of the laboratory, and classified costs according to IA testing volume. We developed a decision analytic model, populated with cost data from 17 laboratories and published assay performance data, to compare the cost-effectiveness of the testing algorithms for a cohort of 30,000 specimens with a 1% HIV prevalence and 0.1% acute HIV infection prevalence. ResultsCosts were lower in high-volume laboratories regardless of testing algorithm. For specimens confirmed positive for HIV antibody, the alternative algorithm (IA, Multispot) was less costly than the current algorithm (IA, WB); however, there was wide variation in reported testing costs. For our cohort, the alternative algorithm initiated with a 3G IA and 4G IA identified 15 and 25 more HIV infections, respectively, than the 1989 algorithm. In medium-volume laboratories, the 1989 algorithm was more costly and less effective than the alternative algorithm with a 3G IA; in high-volume laboratories, the alternative algorithm with 3G IA costs $162 more per infection detected. The alternative algorithm with 4G instead of 3G incurred an additional cost of $14,400 and $4865 in medium- and high-volume labs, respectively. DiscussionHIV testing costs varied with IA testing volumes. The additional cost of 4G over 3G IA might be justified by the additional cases of HIV detected and transmissions averted due to earlier detection. ConclusionThe alternative HIV testing algorithm compares favorably to the 1989 algorithm in terms of cost and effectiveness.

Laboratory Informatics and AIDS Indicator Surveys

Background and Purpose: National AIDS indicator surveys generate large volumes of specimens and associated data, necessitating the preparedness of systems and processes in the reference laboratory. Specimen management is often more routine while management of data becomes secondary. However, complete and accurate laboratory results are essential to ensure data quality. Robust laboratory informatics solutions for managing data are needed to increase data accuracy and reduce turnaround time. Methods: During the 2012 Kenya AIDS Indicator Survey (KAIS), 62,435 samples were collected from respondent households and transferred to the National HIV Reference Laboratory (NHRL) for testing. The Association of Public Health Laboratories (APHL) collaborated with the Kenya Ministry of Health in laboratory process improvement, laboratory information system design and governance focusing on preparing the laboratory to manage the large volume of samples and associated data. This task included developing detailed work flow and data flow diagrams for the entire process, from field specimen and data collection, to receipt, testing and storage. These diagrams were used for training and for reference during the survey process. They were also used to define KAIS 2012 requirements for the existing laboratory information management system (LIMS). Laboratory processes were documented and matched up with the configurations developed in the LIMS. The team also designed specimen tracking and receiving forms based on KAIS 2012 protocol and LIMS requirements. They matched these forms with data elements in the LIMS for data harmonization. The KAIS survey team developed contingency plans for every KAIS 2012 laboratory activity to ensure NHRL implemented uniform procedures when normal operations did not occur. These plans focused on the management and standardization of human resources as appropriate personnel and associated procedures are integral to optimal information system performance. The team defined staff roles and responsibilities and developed procedures for managing forms, specimens and electronic data, including quality and use aligned with survey protocols. During the project, the KAIS team provided knowledge transfer to NHRL to ensure the development of local capacity and long-term sustainability. Results: Due to the informatics processes in place, NHRL was able to share laboratory test results from KAIS with other stakeholders within a day of being received. NHRL was also able to immediately access data on storage locations of all samples that were previously managed using paper systems – a significant challenge before the project. Visualization, mapping and contingency planning for each step of the process ensured that laboratory support to KAIS 2012 was timely, and of high quality, regardless of digressions from standard operating procedures caused by unexpected circumstances. While contingency plans are not routine, they can be critical to the success of the survey. Conclusions: Preparedness is key. Finalization of the survey protocol three months before the pilot, training and piloting all aspects of laboratory services a month prior to the survey ensured informatics solutions are appropriate and robust. Engaging all stakeholders -- particularly survey, laboratory and LIMS staff -- in laboratory informatics solutions planning, implementation, monitoring is critical to developing the most efficient systems and processes for a large national sero survey. During execution, constant and ongoing communication is essential to adapt to the evolving needs of the survey and its participants. Keywords: LIMS/LIS, Informatics, survey

Correction: Cryptococcus gattii in the United States: Genotypic Diversity of Human and Veterinary Isolates

The Funding statement should read: his research was supported in part by an appointment to the Emerging Infectious Diseases (EID) Fellowship Program administered by the Association of Public Health Laboratories (APHL) and funded by the Centers for Disease Control and Prevention (CDC). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

State Public Health Laboratory System Quality Improvement Activities

The Association of Public Health Laboratories (APHL) and the APHL Laboratory Systems and Standards Committee manage the Laboratory System Improvement Program (L-SIP). One component of L-SIP is an assessment that allows the members and stakeholders of a laboratory system to have an open and honest discussion about the laboratory system's strengths and weaknesses. From these facilitated discussions, gaps and opportunities for improvement are identified. In some cases, ideas for how to best address these gaps emerge, and workgroups are formed. Depending on resources, both monetary and personnel, laboratory staff will then prioritize the next component of L-SIP: which quality improvement activities to undertake. This article describes a sample of quality improvement activities initiated by several public health laboratories after they conducted L-SIP assessments. These projects can result in more robust linkages between system entities, which can translate into improvements in the way the system addresses the needs of stakeholders.

Legal Considerations in Cross-Jurisdictional Sharing of Public Health Laboratory Services

The Centers for Disease Control and Prevention and the Association of Public Health Laboratories initiated the Laboratory Efficiencies Initiative in 2011 to help address issues related to public health laboratory (PHL) capacity to perform critically needed tests and services. One approach to improving capacity and efficiency is sharing PHL services with other states or jurisdictions. Cross-jurisdictional sharing implicates numerous federal and state laws, including federal and state privacy laws, laboratory certifications, packaging and shipping requirements for laboratory specimens, and state laws regarding fees and revenue. While federal laws generally do not present insurmountable barriers to sharing PHL services, state laws vary greatly, even within the same region of the country. This article summarizes some of the potentially relevant federal and state legal issues related to cross-jurisdictional sharing. It is important that states interested in cross-jurisdictional sharing consider all relevant laws, potential conflicts of law, as well as inconsistencies with agreements already in place among health departments and laboratories.

Use of Proficiency Testing as a Tool to Improve Quality in Microbiology Laboratories

Proficiency testing (PT) is a valuable tool for assessing laboratory performance and verifying the accuracy and reliability of test results. Participation is required by the Clinical Laboratory Improvement Amendments (CLIA) of 1988 for each of the microbiology subspecialties (bacteriology, mycobacteriology, mycology, parasitology, and virology), and the regulations include specific PT requirements for each subspecialty. To determine the use and perceived value of PT beyond meeting CLIA requirements, the Centers for Disease Control and Prevention funded a cooperative agreement with the Association of Public Health Laboratories to convene a series of focus groups to query laboratory professionals responsible for PT. The seven focus groups were comprised of 60 laboratory professionals representing large and small clinical laboratories, microbiology subspecialties, and public health. While participants acknowledged the need to perform PT to meet regulatory requirements, many also cited benefits and challenges beyond regulatory compliance.

The Laboratory Efficiencies Initiative: Partnership for Building a Sustainable National Public Health Laboratory System

Beginning in early 2011, the Centers for Disease Control and Prevention and the Association of Public Health Laboratories launched the Laboratory Efficiencies Initiative (LEI) to help public health laboratories (PHLs) and the nation's entire PHL system achieve and maintain sustainability to continue to conduct vital services in the face of unprecedented financial and other pressures. The LEI focuses on stimulating substantial gains in laboratories' operating efficiency and cost efficiency through the adoption of proven and promising management practices. In its first year, the LEI generated a strategic plan and a number of resources that PHL directors can use toward achieving LEI goals. Additionally, the first year saw the formation of a dynamic community of practitioners committed to implementing the LEI strategic plan in coordination with state and local public health executives, program officials, foundations, and other key partners.

Milwaukee Laboratory System Improvement Program (L-SIP)

The Laboratory System Improvement Program (L-SIP) of the Association of Public Health Laboratories aims to improve state public health laboratory (PHL) system performance through continuous quality improvement. We successfully applied this state assessment tool to a local PHL (LPHL) system by tailoring it to reflect local system needs and created an LPHL system definition explaining how a local system differs from, yet complements, a state system. On November 18, 2010, 75 stakeholders from 40 agencies assessed the Milwaukee, Wisconsin, PHL system, capturing themes, strengths and weaknesses of the system, and scores for each of the 10 Essential Public Health Services. A Laboratory Advisory Committee analyzed assessment results to identify a strategic focus of research and workforce development and define an action plan, which is now being carried out. Milwaukee's L-SIP process is effectively improving LPHL system research and workforce development while raising community awareness of the system.

Performance of the new HIV-1/2 Diagnostic Algorithm in Florida's public health testing population: A review of the first five months of utilization

ObjectiveThe Centers for Disease Control and Prevention and the Association of Public Health Laboratories have proposed a new HIV-1/2 Diagnostic Algorithm: a fourth-generation HIV-1/2 Ag/Ab immunoassay (IA) followed, when repeatedly reactive, by an HIV-1/HIV-2 antibody differentiation test, and if that is non-reactive, HIV-1 nucleic acid amplification testing (NAT). The objective of the study was to evaluate performance of the new algorithm after five months of utilization in our high volume, high HIV-1 seroprevalence public health population. MethodsAlgorithm sensitivity and specificity was evaluated on 51,953 prospective serum or plasma specimens from individuals self-referring for HIV serostatus determination. Specimens were tested on the day of receipt or maintained at 4°C until the next testing opportunity. If the initial HIV-1/2 Ag/Ab IA (Abbott Combo) was nonreactive, a negative lab interpretation report would follow. If the initial IA was reactive, repeat screening in duplicate was immediately performed. Repeatedly reactive specimens were tested with an HIV-1/HIV-2 differentiation assay (Multispot [MS] HIV-1/HIV-2 Rapid Test) on the same or next workday. If the Abbott Combo-MS assays were discordant, HIV-1 NAT (APTIMA® HIV-1 RNA) was performed. In addition to the algorithm performance, we also evaluated the laboratory “specimen receipt to reporting” turnaround time (TAT). ResultsThe sensitivity and specificity of the new HIV Diagnostic Algorithm with serum and plasma specimens over the initial 5 month period was 100% (922/922) and 99.99% (51,030/51,031), respectively. Two algorithm-defined acute HIV-1 infections (AHI) were detected. In addition only 3 of the 992 MS secondary tests performed were interpreted as HIV-1 Indeterminate (HIV-1 recombinant gp41 reactivity only). Of these, 2 were HIV-1 NAT reactive, defined in-house as an early HIV infection (EHI) and one was HIV-1 NAT nonreactive, indicating a false positive initial screening result. Laboratory TAT for reporting concordant reactive Abbott Combo-MS results in ≤2 workdays was 96%, compared to 22% for reporting concordant reactive 3rd generation IA-Western blot results. ConclusionsIn our public health testing population, results from the new HIV Diagnostic Algorithm exceeded those of the 3rd generation IA-WB algorithm with respect to HIV-1 sensitivity. The identification of two algorithm-defined AHIs provided the opportunity to inform these individuals of their HIV status and link them to medical care earlier than the scheduled posttest counseling appointment.

Variability Among States in Investigating Foodborne Disease Outbreaks

Over 1,100 foodborne disease outbreaks cause over 23,000 illnesses in the United States annually, but the rates of outbreaks reported and successful investigation vary dramatically among states. We used data from the Centers for Disease Control and Prevention's outbreak reporting database, Association of Public Health Laboratories' PulseNet laboratory subtyping network survey and Salmonella laboratory survey, national public health surveillance data, and national surveys to examine potential causes of this variability. The mean rate of reporting of Salmonella outbreaks was higher in states requiring submission of all isolates to the state public health laboratory, compared to those that do not (5.9 vs. 4.1 per 10 million population, p=0.0062). Rates of overall outbreak reporting or successful identification of an etiology or food vehicle did not correlate at the state level with population, rates of sporadic disease reporting, health department organizational structure, or self-reported laboratory or epidemiologic capacity. Foodborne disease outbreak surveillance systems are complex, and improving them will require a multi-faceted approach to identifying and overcoming barriers.

The cold weather plan

British Journal of Healthcare AssistantsVol. 5, No. 12 Health MattersThe cold weather planRhidian HughesRhidian HughesSearch for more papers by this authorRhidian HughesPublished Online:16 Aug 2013https://doi.org/10.12968/bjha.2011.5.12.612AboutSectionsView articleView Full TextPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InEmail View article References Association of Public Health Laboratories (2011) Available: http://tinyurl.com/APHLDEATH Google ScholarDepartment of Health (2011a) Cold weather plan. Protecting health and reducing harm during severe cold. Available: http://tinyurl.com/CCC0o0LD Google ScholarDepartment of Health (2011b) Making the Case: Why cold weather planning is essential to health and well-being. Available: http://tinyurl.com/cy73v37 Google ScholarDepartment of Health (2011c) Seasonal Flu Plan. Available: http://tinyurl.com/7xxp3o5 Google Scholar FiguresReferencesRelatedDetails 1 December 2011Volume 5Issue 12ISSN (print): 1753-1586ISSN (online): 2052-4420 Metrics History Published online 16 August 2013 Published in print 1 December 2011 Information© MA Healthcare LimitedPDF download

Evaluation of an alternative supplemental testing strategy for HIV diagnosis by retrospective analysis of clinical HIV testing data

Background Because newer screening assays are more sensitive than traditional confirmatory assays, a new HIV testing algorithm was proposed by the Centers for Disease Control and Prevention (CDC) and Association of Public Health Laboratories (APHL) in 2010 to replace the current enzyme immunoassay (EIA)–Western blot (WB) algorithm that was established in 1989. The new algorithm includes a sensitive screening EIA and a HIV-1/HIV-2 differentiation immunoassay (Multispot) for confirmation. Concordant reactive specimens are reported as HIV-1 and/or HIV-2 positive; those with discordant results receive nucleic acid testing (NAT). Objective Our laboratory uses all components of both the current and proposed algorithms and conducted a retrospective analysis of test results to compare algorithm performance. Study design All available test results from 38,257 specimens were analyzed, of which 36,598 were EIA non-reactive. Of 1659 EIA-reactive specimens, 1578 were defined by our laboratory as HIV-1 positive, 5 as HIV-2 positive, 69 as negative and 7 as unknown. These results were used to evaluate both algorithms. Results Under the proposed algorithm, all 1578 HIV-1-positive specimens would be reported as ‘HIV-1 positive’, whereas the current algorithm only confirmed 98% (1546/1578). The proposed algorithm produced fewer inconclusive results (9 vs 48); consequently, fewer follow-up specimens would be needed. The current algorithm produced one false-positive result whereas the proposed algorithm produced four. Two of these four false-positive results could be eliminated by requiring NAT for specimens with discordant HIV-1 results on the Multispot. Although both algorithms identified all HIV-2-positive specimens, the current algorithm required an additional 112 tests. Conclusion The CDC/APHL HIV testing algorithm, proposed in 2010, outperformed the current algorithm because it was more sensitive for detecting HIV-1 infection, provided a greater number of definitive HIV results, and detected HIV-2 more efficiently.

Public Health Laboratories and Radiological Readiness

To document the ability of public health laboratories to respond to radiological emergencies. The Association of Public Health Laboratories developed, distributed, and analyzed two separate surveys of public health laboratories representing the 50 US states and major nonstate jurisdictions. The 2009 All-Hazards Laboratory Preparedness Survey examined overall laboratory capability and capacity, with a subset of questions on radiation preparedness. A 2011 survey focused exclusively on radiation readiness. The 50 state and District of Columbia public health laboratories responded to the 2009 All-Hazards Laboratory Preparedness Survey, representing a 98% response rate. In addition to the above laboratories, environmental and agricultural laboratories responded to the 2011 Radiation Capabilities Survey, representing a 76% response rate. Twenty-seven percent of the All-Hazards Survey respondents reported the ability to measure radionuclides in clinical specimens; 6% reported that another state agency or department accepted and analyzed these samples via a radioanalytical method. Of the Radiation Capabilities Survey respondents, 60% reported the ability to test environmental samples, such as air, soil, or surface water, for radiation; 48% reported the ability to test nonmilk food samples; 47% reported the ability to test milk; and 56% reported sending data for drinking water to the Environmental Protection Agency. Survey data reveal serious gaps in US radiological preparedness. In 2007, federal experts estimated it would take more than 4 years to screen 100 000 individuals for radiation exposure and 6 years to test environmental samples from a large-scale radiological emergency, relying on existing laboratory assets. Although some progress has been made since 2007, public health laboratory radiological test capabilities and capacities remain insufficient to respond to a major event. Adequate preparation requires significant new investment to build and enhance laboratory emergency response networks, as well as investments in the broader public health system in which public health laboratories function.

Treponema-Specific Tests for Serodiagnosis of Syphilis: Comparative Evaluation of Seven Assays

The diagnosis of syphilis is challenging and often relies on serologic tests to detect treponemal or nontreponemal antibodies. Recently, the Centers for Disease Control and Prevention and the Association of Public Health Laboratories proposed an update to the syphilis serology testing algorithm, in which serum samples are first tested using a treponema-specific test and positive samples are analyzed with a nontreponemal assay. The goal of this study was to compare the performance of seven treponemal assays (BioPlex 2200 syphilis IgG [Bio-Rad, Hercules, CA], fluorescent treponemal antibody [FTA] assay [Zeus Scientific, Raritan, NJ], Treponema pallidum particle agglutination [TP-PA; Fujirebio Diagnostics, Malvern, PA], Trep-Sure enzyme immunoassay [EIA; Phoenix Biotech, Oakville, Ontario, Canada], Trep-Chek EIA [Phoenix Biotech], Trep-ID EIA [Phoenix Biotech], and Treponema ViraBlot IgG [Viramed Biotech AG, Planegg, Germany]) using serum samples (n = 303) submitted to our reference laboratory. In addition to testing with these 7 assays, all samples were tested by a rapid plasma reagin (RPR) assay and a treponemal IgM Western blot assay (Viramed ViraBlot). Compared to the FTA assay as the gold standard, the evaluated treponemal tests demonstrated comparable levels of performance, with percent agreement ranging from 95.4% (95% confidence interval, 92.3 to 97.3) for the Trep-Sure EIA to 98.4% (96.1 to 99.4) for the Trep-ID EIA. Compared to a "consensus of the test panel" (defined as at least 4 of 7 treponemal tests being in agreement), the percent agreement ranged from 95.7% (92.7 to 97.5) for Trep-Sure to 99.3% (97.5 to 99.9) for Trep-ID. These data may assist clinical laboratories that are considering implementing a treponemal test for screening or confirmatory purposes.

International Conference on Emerging Infectious Diseases, 2010

The seventh International Conference on Emerging Infectious Diseases (ICEID) was held in Atlanta, Georgia, USA, July 11-14, 2010. The conference goal was to bring together public health professionals to encourage exchange of scientific and public health information on global emerging infectious disease issues. The conference was organized by the Centers for Disease Control and Prevention (CDC), American Society for Microbiology, the Council of State and Territorial Epidemiologists, the Association of Public Health Laboratories, and the World Health Organization; additional support was provided by 40 other multidisciplinary public health partners.

A review of sentinel laboratory performance: identification and notification of bioterrorism agents.

Abstract Context.—The anthrax incident of 2001 in the United States prompted the College of American Pathologists (CAP), the Association of Public Health Laboratories, and the Centers for Disease C...